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VA Caregiver Program Application, Benefits, and Requirements Explained

VA Caregiver Program Application, Benefits, and Requirements Explained

Video Transcription

Kayla: Hello and welcome to CCK Live. My name is Kayla D’Onofrio. I’m an accredited claims agent here at CCK. I’m joined today by my colleagues, Bethany Cooke and Brandon Paiva, also accredited claims agents here at the firm. Today, we’re going to be breaking down VA’s Caregiver Program.

We’ll just start with the very basics. What is a VA caregiver? Caregivers play an important role in the health and well-being of a lot of veterans. Typically, a caregiver is a spouse or a family member of a veteran who leaves their job to care for the veteran full-time due to the extent or nature of the veteran’s disability.

Common disabilities that might require a caregiver include things like traumatic brain injuries, post-traumatic stress disorder, paralysis, amputation or loss of limbs, or things like deafness or blindness. Brandon, what are some of the duties that a caregiver may be performing or providing for a veteran who needs that kind of assistance?

Brandon: That’s a good question, Kayla. So, we’re going to define what are the duties of this caregiver? So essentially, the duties of a caregiver involve helping the veteran with personal care services. Now, personal care services offer further services, a caregiver may provide to a veteran to assist with their activities of daily living or often what we refer to as ADLs.

VA does outline that caregivers can assist with personal care services when the veteran is unable to perform these tasks on their own. These ADLs may include things like bathing or personal grooming; dressing and undressing; eating and preparing food; adjusting a prosthetic or orthopedic device, or even assisting the veteran with their mobility; supporting the veteran’s safety which can occur in instances where the veteran may harm themselves without assistance; aiding the veteran through instruction regarding their daily living environments; and essentially, just supporting the veteran’s day-to-day life.

Kayla: Great. Thank you. So, now that we’ve kind of outlined very basically what a caregiver is, Bethany, can you give us some details about what the VA caregiver program entails?

Bethany: Sure. So, the caregiver program, also known as the Comprehensive Assistance for Family Caregivers Program, was initially established in 2011 to provide benefits to caregivers of post 9/11 disabled veterans. So, at the time, it was created in recognition of the potential time and financial loss that can result from being a part or full-time caregiver to disabled veterans who are in need of a high level of assistance.
As obviously, if you are providing part or full-time caregiving services that might impact your ability to be able to earn an income.

So, this program was actually recently expanded in October 2020. Congress expanded the mission act to include caregivers of veterans who served before May 1975. So, the program is set to expand its offerings in two phases over the next few years to encompass veterans of all eras. So, we’ll no longer be limited to post 9/11 veterans.

Phase one, which was effective October 1, 2020, allows family caregivers of veterans who were seriously injured in the line of duty on or after May 7, 1975, to be eligible. And then phase two, which is effective after two years will allow family caregivers of veterans who are seriously injured in the line of duty between May 7, 1975 and September 10, 2001 to become eligible.

Kayla: Great. And some of the benefits that would be available to these caregivers include things like a monthly stipend; travel expenses, which would include lodging and per diem while accompanying the veteran for undergoing care; access to healthcare insurance if the caregiver isn’t already entitled to care or services under a current health plan; mental health services and counseling; comprehensive VA caregiver training; and respite care not less than 30 days.

For the program, there are certain eligibility requirements that both the veteran and the caregiver do have to meet in order to get this benefit granted. So Brandon, can you go over some of those requirements?

Brandon: Absolutely. Eligibility is determined typically by the Veterans Health Care Administration, but those caregivers can appeal those decisions that deny their eligibility. So, in short, caregivers must be at least 18 years old, be the spouse, child-parent, stepparent, stepchild, or extended family member of the veteran, and live with the veteran full-time or be willing to if designated as the family caregiver. For caregiver assistance, a veteran must be a veteran or a member of the Armed Forces undergoing a medical discharge; having individual or combined VA disability rating of 70% or higher; the veteran must have served during one of the following periods, kind of similar to what Bethany Cooke touched on a few moments ago, you need to have served on or after September 11, 2001, or on over for May 7, 1975. Veterans must also have service-connected disabilities which were caused or aggravated by active duty service, and meet at least six months of continuous in-person, personal care services.

So, there is a number of qualifications, a number of requirements that not only the caregiver must show to VA when applying for these benefits, but also, the veteran must show in order to qualify for these benefits as well.

Kayla: Great. And Bethany, what steps is VA going to take to determine whether you do meet those eligibility requirements?

Bethany: Yeah. So, the thing that they’ll typically do is schedule the veteran for compensation and pension (C&P) examination, to determine if the veteran is eligible and how much assistance they may need. So, essentially, the examination is going to rate the veteran based on how they’re able to perform the activities of daily living that Brandon talked about a little earlier. And they do that by putting their activities of daily living, their ability to perform them, into one of three categories.

So, the first category is high dependence. They rate this with the numbers 21 to 28. If a veteran gets this rating, it indicates that they need a full-time caregiver who will provide at least 40 hours of personal care services per week. The next rating is moderate dependence, they use the numbers 13 to 20 to get this determination. If a veteran meets the moderate dependence category, then they likely need 25 hours of caregiver assistance per week. And then, the final category is low dependence, so if they get a rating between 1 to 12. If the veteran is in this category, then they typically need 10 hours of caregiver assistance per week.

Besides determining how much time of caregiving services the veteran needs, they will also determine whether the veteran needs supervision or assistance in any of the following instances. So, these are safety concerns, for example, if the veteran has difficulty assessing risks or experiences frequent falls, has memory difficulties. Other instances would be if the veteran’s prone to seizures, has difficulty with life planning. For example, if they’re unable to manage their medication schedule or their finances, as well as difficulties with mental disorders or conditions, difficulties with mood disorders or conditions, and sleep irregularity.

Kayla: Great. Thank you, Bethany.

Bethany: So what we use…

Kayla: Go ahead. I’m sorry.

Bethany: No, it’s okay. I was just going to say, just like with any other claim, they also will consider your medical records. They might request those.

Kayla: Absolutely. Great. Thank you so much. Now if you are thinking that you do fall into some of these eligibility requirements and you do want to apply for this program, VA does require a specific form just like they would for any other benefit. The form that they require for the caregiver program is the VA form 10-10CG, which is called the application for the program of comprehensive assistance for family caregivers. The form does have sections for providing information, including the veteran’s identification information, the caregiver’s identification information, as well as information if there is a secondary family caregiver.

Secondary caregivers may be eligible for the same benefits that the primary caregiver is, particularly in instances where the veteran does require more than one individual’s assistance as part of their daily routines. There’s a lot of things that both the caregiver and the veteran should be prepared for when they’re kind of going through this claims process. So, Brandon, can you give some tips that might help to get families approved for this program?

Brandon: Absolutely. And again, just like you would state, these benefits are available but finding your way to applying for these benefits or even finding out, do you apply? How do you apply? What do I need to show? Those can be kind of difficult waters to navigate. So, we’re going to go over just a few tips that we have here at CCK that initially help you if you have fallen into any of these circumstances.

While the application process for becoming approved for the VA caregiver program may seem daunting, there are a few things veterans and their caretakers can do to really kind of help boost their chances of success in applying to this program and hopefully getting granted these benefits.

So, when we’re talking about veterans. Veterans should be prepared for a home visit with a VA clinician, which is usually one of the first steps, kind of similar to a CMP examination. The veteran would want to talk about specific activities of daily living or the ADLs in which they require assistance. And then follow through with definitely any C&P examinations that they may be scheduled for after the initial VA clinician visit.

Now, we’re talking about caregivers. Just some tips we have for the caregiver as well, complete all the caregiver training that is required of you. There could be a number of forms that you may have to fill out, maybe a couple of other tasks you may need to complete. Make sure you complete everything so that way, you can make sure that your eligibility requirements are fulfilled.

Another thing that we want to do, just as a veteran, is we encourage them to be honest during the VA clinician visit with exactly how much assistance they need and how often. We want the caregivers to be honest as well. Be honest about the type of tasks that the caregiver assists the veterans with, with the veteran’s care schedule and any other specific details that may help kind of paint a picture of you as a caregiver, what exactly do you have to go through on a daily basis to assist the veteran to ensure that they’re living a safe and fulfilled life.

And if you have any questions about this, because again these parts are difficult to navigate as the caregiver, you can always contact the caregiver support coordinator to assist with any of the questions. I believe the information can be found on VA’s website, you just search the program. There’s a number of resources available out there. As far as FAQs, we have this CCK Live that we’re putting out as well to hopefully help veterans kind of navigate this with their caregiver situation, as well.

Kayla: Great. Now, what VA is going to do is they’re going to take a look at all this information and they’re going to issue a decision which either grants or denies eligibility for this caregiver program. Now, if you are denied this benefit, it doesn’t necessarily mean it’s the end of the road for you. So, Bethany, can you go into some options that veterans and their caregivers may have if they are denied?

Bethany: Yes, so this is actually only very recently clarified, that you can actually go through the appeals process with a caregiver benefit denial. But once they issue a decision, like Kayla said, you do have appeal rights. So, if you disagree in whole or in part with a VA decision, under the program of comprehensive assistance for family caregivers, you have a few options. So, the first option is to file a supplemental claim.
And this option is only available for decisions provided by the VA on or after February 19, 2019. So, this would require you to submit new and relevant evidence in the new appeal system.

The second option is to file a Higher-Level Review decision. And this is again, only available for decisions decided on or after February 19, 2019. And the Higher-Level Review decision, you would not be able to supply any new evidence. They would take a look at the decision as it was issued based on the evidence already of record to determine if there were any errors.

And the last option is to file an appeal to the Board of Veterans’ Appeals, and this option is available for all decisions regardless of the date the decision was provided.

The Veterans Health Administration also offers the clinical review process. So, this is different from filing an appeal. If you disagree with one or more caregiver decisions regardless of when those decisions were made, you can choose this option which will remain in VHA.

Kayla: And there’s a lot to kind of to take in here. It’s kind of difficult waters to navigate as we sort of alluded to throughout the presentation. So, if you are confused on what you need to do, whether you’re eligible, or really what your options might be, we definitely do recommend seeking help from an accredited representative, whether that be a Veteran Service Organization or another accredited attorney, or accredited claims agent, just to kind of help you navigate the waters a little bit because we do know that it can be rather complicated.

But with that, I do think that’s a good place for us to wrap up today. For more information on VA’s caregiver program, you can go ahead and visit our website at cck-law.com. Thank you so much for tuning in today. And be sure to subscribe to our channel for more veteran-related videos.